It would go far toward excluding the 30 to 50 per cent tuberculous subjects who broke down in the British army. Second, a thorough examination of the chest by the well-known methods, and of the glandular system accessible by palpation.

If these two conditions are faithfully fulfilled many lives may be saved if an opportunity is given to separate all suspected cases for more careful study before acceptance. I know of no short cuts to a diagnosis of concealed tuberculosis. It requires time and often repeated examinations. There are no infallible tests, but several valuable helps. The fluoroscope is one of the quickest if made available. Roentgenograms and, if feasible, stereograms are still more useful, but can hardly be applied on a large scale unless a well organized system is instituted. The tuberculin skin tests are of little value unless the results are repeatedly and persistently negative. The sub-cutaneous test requires much care and experience. Both have no value as positive tests in adults except in confirming other evidence. The serum reaction with complement fixation is attracting more attention as a confirmatory test, and I believe is of greater value than tuberculin. All other refinements of diagnosis in tuberculosis. are of such limited value that they can be dismissed with mere mention in this connection. When it is impossible for sanatorium physicians after prolonged observation to confirm or disprove a considerable percentage of suspected cases, The difficulties are at once appreciated when the recruiting problem is contemplated and time is limited. The sifting process must of necessity be coarse unless a thorough-going organization and ample observation facilities are provided. Every possible precaution will doubtless be instituted.

Finally, a question of great importance is the proper supervision of men who may be accepted on probation, if that can be done. Many will break down in civil life who might improve in health and vigor from the military regime and later become more valuable citizens because of it. It were a pity to lose this opportunity, but if it is impracticable, our anti-tuberculosis agencies ought to be engaged in the worthy cause of following up these cases.

VALUE OF TUBERCULOSIS HOSPITALS.

A study of 1,056 patients discharged from sanatoria in Massachusetts shows 46 per cent were in far advanced stage on admission. Each of the 1,056 patients were visited within three months after discharge. Of the 1,056 patients, 433 were still alive, 485 had died and 138 had left the state, or their whereabouts were unknown. Of those who are alive 312 are in good condition and regularly at work. Of these 312 patients, 35 per cent were incipient, 43 per cent moderately advanced and 22 per cent far advanced on their admission to the sanatorium.

LAST MEETING OF STATE BOARD OF HEALTH.

The June meeting of the State Board of Health which was the final meeting of the old board was held at Columbus, June 21. There were present Drs. Howell, Hasencamp, Brown and Smith and Attorney General McGhee.

The Secretary reportd that the local public health work was threatened with serious interruption by reason of many public health nurses enlisting for war service and presented the following resolution which was adopted:

"WHEREAS, The Ohio State Board of Health, after due consideration of the nature and value of the services that may be rendered by the public health nurse, has established in its division of public health education a bureau of public health nursing, the duty of such bureau being the placing and supervision of public health nurses in communities where a demand for such service is made, and

"WHEREAS, The General Medical Board is making plans for special supervision of this field, which it is hoped will prevent unnecessary crippling of the essential work of local health protection, while at the same time making provisions for the release of the necessary number of nurses for foreign service, and,

"WHEREAS, A condition of war requiring the establishment of training camps in various parts of the country, making necessary the moving of a larger number of men and the inaugurating of a different mode of living for a great part of the population, which condition may seriously affect the public health of the country generally and particularly conditions in communities near which training camps may be located, and

"WHEREAS, The departure of the men and youths who are enlisting for war service will take from many families their protectors and breadwinners, thus in many instances lowering the family income and standard of living, will bring about abnormal social conditions by sending women and girls into industrial positons, leaving the aged, the prospective mothers, infants and children without their usual care and comforts and will cause more than ever before the demand for the services which the public health nurses are giving and are especially qualified by their training to give, therefore, be it

"Resolved, That while there are other nurses available for Red Cross work, the State Board of Health of Ohio would urge that nurses engaged in public health work seriously consider their responsibility for rendering that service to the nation for which they are best fitted by their training and experience before leaving their posts; that the general public be informed that by so remaining the public health nurse is helping to conserve the most precious of our national resources human life and is serving her country no less truly than the nurse who goes to the front; and that the General Medical Board secure pronouncement from the Council of National Defense recognizing public health nursing as a war service."

The Board also took up for consideration the plan of enlarging

facilities of the district tuberculosis hospitals of the state in order to take care of the cases of tuberculosis that may arise because of war conditions. The board endorsed the resolution adopted by the Ohio State Medical Association at its Springfield convention on this subject.

The appointment of William C. Groeniger to the position of State Inspector of Plumbing and the granting of a leave of absence to Dr. J. R. McDowell, Director of Public Health Education for military service, effective June 1, 1917, were confirmed.

Approval of plans for proposed sewerage and sewage disposal for a centralized school building in Union Township, Champaign county, and for a centralized school building in Brown Township, Delaware county were confirmed. The board approved plans for a new water supply for Bradford, a proposed additional water supply for Arcanum, additional water supply for Canton, a proposed water works improvement for Greenville, a proposed disinfection plant for the public water supply of Mingo Junction, a proposed water supply for the Cleveland Boy's Farm, Summit County, proposed additional sewerage and sewage treatment plant for Barberton. A proposed temporary sewer outlet to serve the Payne Avenue sanitary sewer, Cuyahoga Falls, was disapproved.

Extension of time was granted to the city of East Liverpool for the installation of proposed additional sewerage to June 1, 1918. Re vised plans were approved for a proposed sewage treatment plant for Shore Haven Allotment, Euclid. The request of the council of the village of Greenfield for an extension of time for the installation of the outlet extension sewer was granted. Revised plans call for the awarding of the contract for the work prior to July 1, 1918.

Plans were approved for proposed sewerage for the Sugar Creek district and the Albert Street District, Youngstown.

The Secretary presented a report of the referees, appointed under authority of Section 1257 of the General Code, in the matter of the order of the State Board of Health to the City Water Works Company City-Crescent Water Company) of Pittsburg, owning and operating the water supply of Sebring and called attention to the fact that the scope of the investigation by the referees was not in accord with an opinion rendered by the Attorney General of Ohio under date of April 16, 1917. The report was referred to the Attorney General for advice as to further procedure, upon recommendation of the Secretary.

The following health officers appointed by their respective councils to serve in lieu of a board of health were approved: Aberdeen, J. L. Schlitz; Byesville, Edward Nichols; Casstown, John H. Harbaugh; Crooksville, Thomas Maxwell; Custar, B. B. Richardson; Holgate, Henry Knapp; Jacksonville, David Kinder; Jerry City, A. W. Gobel; New Bloomington, W. G. Dutton; Reynoldsburg, B. L. Slack; West Alexandria, John N. Kelly; Yorkville (Jefferson Co.), Charles T. Herrlein.

The Board of Health of Blendon township, Franklin county, having failed and refused after repeated notice to appoint a health officer, the board appointed Dr. O. B. Cornell, health officer for the township at a salary of $60 a year, to serve until July 21, 1918.

The board granted a license to conduct a maternity boarding house

and lying-in hospital to the Elizabeth Home, 1361 Hunter Ave., Col., and renewed the license to the Bethsan Home, 1600 Harrisburg Rd., Canton.

BABIES DYING IN POOR HOMES-LOW WAGES OF FATHERS THE CAUSE.

Low wages of fathers and the gainful employment of mothers away from home accompany an excessive death rate among babies in Manchester, N. H., according to the report on infant mortality in that city, which has just been issud by the Children's Bureau of the U. S. Department of Labor.

The study was based primarily on interviews with the babies' mothers. It was absolutely democratic in scope and included all babies whose births were registered during a single year and whose families could be found. Of all the babies studied, one in six- 165 per 1,000 -had died during the first year of life. There were wide variations in rate between different groups of the population, according to the fathers' earnings, the employment of the mother, the congestion of the home, and the way in which the baby had been fed.

Nearly half of the 1,643 babies had fathers whose earnings were less than $650 a year, and more than one-eighth of the babies had fathers earning less than $450 a year. Only one in sixteen (6.4%) had fathers earning as much as $1,250. The death rate among the babies in the poorest families was more than four times as high as among those in the highest wage group.

Low earnings on the part of the father appear to be the most potent reason for the mother's going to work. Where the fathers earned less than $450 a year almost three-fourths of the mothers were gainfully employed during some part of the year after the baby's birth. As the fathers' earnings rise the proportion of working mothers falls until in the group where fathers earned $1,050 or over, less than one-tenth of the mothers worked.

Keeping lodgers was the chief occupation of those who worked at home and working in the textile mills was the chief occupation of those who worked away from home. The mothers of 267 babies went out to work during the first year of the baby's life and these babies had a death rate considerably higher than those whose mothers worked at home, or were not gainfully employed. The rate is especially high -277.3 per 1,000- among the 119 babies whose mothers went out to work before they were 4 months old.

The babies were grouped also according to the kind of house in which the family lived. The death rate for babies whose homes were in one-family houses was 86.1 per 1,000; in houses containing seven or more families 236.6 per 1,000. Similarly the rate showed a steady increase according to the number of persons per room. It was 123.3 per 1,000 where the family had more rooms than persons; and 245.9 where there were two or more persons per room.

In each economic group the babies who were artificially fed had fewer chances of survival than the babies whose mothers nursed them. But the economic status of the family modifies the influence of feeding, and the difference in the death rates for breast-fed babies and artificially fed babies is least striking in the highest income group.

GENERAL INSTRUCTIONS FOR HAY-FEVER SUBJECTS. Issued by The American Hay-Fever-Prevention Association.

In accordance with its annual custom, the American Hay-FeverPrevention Association has issued the following instructions for the benefit of its members and hay-fever subjects generally:

There are two forms of hay-fever in the United States, the vernal and the autumnal forms. While these vary somewhat in the different States, the average dates are from May 15th to July 20th for the first and August 17th to October 1st for the second form.

The vernal form of hay-fever is due principally to the pollen of the grasses in all parts of the United States. East of the onehundredth parallel, the principal cause of autumnal hay-fever is the pollen of the common Rag-weed, the Giant rag-weed, marsh elders and cockle burs replacing this in some sections or aggravating the infection.

West of Kansas, autumn hay-fever is principally due to the wormwoods (artemisias) of which there are many varieties in the Pacific and Rocky Mountain States. The western rag-weed, marsh elder, gaertnerias and cockle burs are associate causes in some localities.

As the control of the hay-fever weeds is of the first importance in hay-fever, every one should cooperate with the health authorities in enforcing the anti-weed laws, which already exists in most cities. Efforts are now being made to establish adequate anti-hay-fever legislation in every State, the enforcement of which will stamp out hayfever in most localities.

In order to prevent or diminish the irritating cause of this disease, hay-fever subjects should avoid roads adjoining fields with neglected weeds during the hay-fever season. An attack due to such exposure lowers the patient's resistance, so that for a long time afterwards he is more susceptible to the hay-fever pollens.

In the majority of cases, a diet reduced in meat, fish, cheese, milk, etc., is of benefit in diminishing the attack, and vegetables and fruit should be given the preference: Smoking and alcoholic drinks should be avoided.

Remedies containing cocaine and other habit-forming drugs should be avoided. Immunizing treatments should be conducted only under the care of a competent physician.

If you suffer from hay-fever, write to your State Representatives in regard to the enactment of a suitable anti-hay-fever weed law. If the one million hay-fever subjects in the United States make this demand, there will soon be no necessity for publishing these annual instructions.

DR. WM. SCHEPPEGRELL,

President American Hay-Fever-Prevention Association.